Secondary Logo

Journal Logo

Prostate Cancer: Localized: Surgical Therapy VI (MP64): Moderated Poster 64: Monday, September 13, 2021

MP64-04 MPMRI FOR STAGING OF PROSTATE CANCER: A MULTICENTRIC ANALYSIS OF PREDICTIVE FACTORS TO IMPROVE IDENTIFICATION OF EXTRACAPSULAR EXTENSION BEFORE RADICAL PROSTATECTOMY

Regis, Lucas; Triquell, Marina; Winkler, Mathias; Piñero, Adrià; López-Molina, Cintia; Valdés, Nicolás; Cuadras, Mercè; Celma, Ana; Planas, Jacques; Morote, Juan; Trilla, Enrique

doi: 10.1097/JU.0000000000002104.04
  • Free

INTRODUCTION AND OBJECTIVE:

Staging for high-risk prostate cancer (PCa) is important in the surgical planning for radical prostatectomy (RP). The correct identification of extracapsular extension (ECE) on mpMRI is crucial in order to plan the nerve-sparring approach. The aim of this study was to asses the negative predictive value of mpMRI in detecting ECE before RP; and in identifying possible operative variables that predict ECE in the final prostatic specimen.

METHODS:

We retrospectively investigate the prostatectomy data base of two tertiary high-volume hospitals to identify men who underwent prostate biopsy with pre-biopsy mpMRI and subsequent RP. Positive and negative predictive value of MRI to detect pT3a disease was assessed. Univariate and multivariate analysis were performed.

RESULTS:

Of a total 1263 RP, 1147 patients met our inclusion criteria. The mean PSA was 9.23 and 37.4% had positive DRE. MRI stage iT3+ were found in 248 (21.6%); 203 (17.7%) with iT3a. Univariate analysis showed that MRI staging was statistically correlated with with pathological staging, p<0.01. MRI positive predictive value to detect ECE in the final pathological specimen was 42%. The ability of mpMRI to exclude ECE was greater and the negative predictive value was 73%. We performed a multivariate analysis including PSA, PSA density (PSAd), % of core affected, biopsy ISUP, and DRE. PSAd and DRE were the only independent predictors of ECE in the final specimen. Analyzing the ROC curve (AUC 0.66), PSAd ≥ 0.20ng/dL/mL was the best threshold to predict stage pT3a.

CONCLUSIONS:

mpMRI seems to be an appropriate tool to exclude ECE thereby facilitating the planning of the nerve-sparing approach. Patients with ECE on MRI, a normal DRE and a PSAd <0.20 ng/dL/mL are unlikely to have ECE disease in the final pathological analysis and may be suitable for extrafascial nerve-sparig strategies. Additional radiomic analysis may improve the detection of ECE further.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.